Drug interactions occur when one drug alters the effects of other drugs. Altered drug action can be more or less reactive. Individual reactions vary. Factors that can affect offspring among other properties, liver and kidney function, age (which is the most sensitive babies and people aged over 50 years), presence or absence of a disease, the amount of drug used, duration of treatment, the time between the use of two drugs, and which drugs are used initially. Therefore their effects may not mean anything to anyone but very dangerous for others. The basic thing that should be realized is that the hazard may occur.

Drugs taken through four basic processes in the body. From the mouth, to the stomach medicine, and then to the intestines. Here the drug is absorbed into the bloodstream and spread throughout the body so that it appears the effect. Drugs or dimetabolisis then described by the liver. Finally, a form of medicine that has been described, is excreted in the urine through the kidneys. On drug interactions, a drug other drugs that change in one or more pharmacological processes. This type of interaction is called pharmacokinetic interactions. The other main type of interaction is a pharmacologic interaction. On this type, the effect of a drug will increase (synergism) or reduce the effects of other drugs (antagonism) effects of the second drug.

Classification of Cardiac Drugs and Drug Interactions

The most common heart disorder occurs is angina, cardiac arrhythmias, and withered heart. Pain angina occurs when the heart does not receive enough oxygenated blood. This occurs when blood flow through a coronary artery is blocked, usually due to blockage of that line the inside of the arteries. This unpleasant situation usually occurs when the heart has to work harder, such as the physical fatigue and emotional stress.

Wilting occurs when the heart fails to pump blood the heart immediately after blood entry. This causes blood to accumulate in the lungs so that the breath will be short and to accumulation of fluid in body tissues. Cardiac drugs are grouped into 6 sections, namely:

1. Angina drug

Angina drug reduces angina pain by improving blood supply and oxygen to the heart. Name angina drug patent (generic name in parentheses):

Ø Cardilate (eritritil tetranitrate)

Ø Duotrate (pentaerythritol tetranitrate)

Ø Isordil (isosorbida dinitrate)

Ø Nitro-BID (Nitroglycerin)

Ø Nitro-Dur (nitroglycerin, transmukosal)

Ø Persantine (dipiridamol)

2. Antiaritmika

This drug normalize irregular heartbeat. Antiaritmika name drug patent (generic name in parentheses):

Ø Quinidex Extentabs (kinidin)

Ø Procan (prokainamida)

Ø Norpace (disopiramida)

3. Beta Blocker Heart Drug

Beta blockers are drugs that a lot of heart function. In addition to eliminating the pain of angina and normalize the heart rate, the drug is also effective menurunksn blood pressure. Beta blockers are also used for other purposes such as to prevent migraine headaches. Names of beta blockers medicines patent (generic name in parentheses):

Ø Blocadren (timolol)

Ø Corgard (nadolol)

Ø Inderal (propranolol)

Ø Lopressor (metoprolol)

Ø Tenormin (atenolol)

Ø Visken (pindolol)

4. Cardiovascular Drugs Calcium Blocker

Calcium blocking drugs is the latest development of cardiovascular medicine. This drug can reduce angina pain that can not be addressed with other drugs. Verapamil is effective against certain types of cardiac arrhythmias. Name of calcium blocking drug patent (generic name in parentheses):

Ø Calan (verapamil)

Ø Cardizem (diltiazem)

Ø Isoptin (verapamil)

Ø Procardia (nifedipine)

5. Heart drug Digitalis

Similar drug digitalis increase the power and efficiency of the heart and is used to treat heart wither and normalize irregular heartbeat. Name of the heart drug digitalis patent (generic name in parentheses):

Ø Crystodigin (digitoksin)

Ø Digifortis (digitalis)

Ø Lanoxin (digoxin)

Ø Purodigin (digitoksin)

6. Diuretics

Diuretics remove excess body fluids and is often used to treat heart wither. Name drug patent diuretic (generic name in parentheses):

Ø Aldactone (spironolactone)

Ø Anhydron (siklotiazida)

Ø Aquatag (benztiazida)

Ø Aquatensin (metiklotiazida)

Ø Lasix (furosemide)

Ø Midamor (amiloride)

Ø Naqua (triklormetiazida)

Ø Zaroxolyn (metolazon)

Heart Drug Interactions

· Drug interactions angina / antiaritmika

Angina drug / antiaritmika - Beta Blocker

This combination can cause blood pressure to drop too low. As a result: postural hypotension with symptoms: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. Drug given beta blockers in angina, to normalize heart rate and to lower high blood pressure.

Angina drug / antiaritmika - Diuretics

This combination can cause blood pressure to drop too low. As a result: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. Diuretics remove excess fluid from the body and is used to treat high blood pressure and heart withered.

Angina drug / antiaritmika - high blood pressure medicine

This combination can cause blood pressure to drop too low. As a result: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. High blood pressure medications are used to lower high blood pressure.

Angina drug - Alcohol (beer, liquor, wine, etc.)

This combination can cause blood press down too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. This interaction can be minimized by reducing alcohol consumption.

Angina drug - vasodilators

This combination can cause blood pressure to drop too low. consequently; postural hypotension with accompanying symptoms: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. Vasodilators dilate blood vessels and is used to treat circulatory disorders, such as arteriosclerosis (hardening of the arteries).

Antiaritmika - Antidepressants (type cyclic)

This combination can cause adverse effects on the heart. As a result: the possibility of cardiac arrhythmias. Antidepressants are used to reduce mental depression and improve mood. Note: antidepressants trazadon (Desyrel) do not interact.

Disopiramida - Phenytoin

Disopiramida effects can be reduced. As a result: irregular heartbeat that can not be controlled. Phenytoin is used to control seizures in disorders such as epilepsy.

Prokainamida - Antacids

Prokainamida effect can be increased. As a result: too many prokainamida can lower blood pressure, heart clogging (reduces nerve transmission required for irregular heartbeat) or has a very irregular heartbeat called ventricular fibrillation dangerous.

Kinidin - Antacids

Effects can kinidin msningkat. As a result: too many kinidin can lower blood pressure, heart clogging (megganggu nerve transmission required for irregular heartbeat), or has a very irregular heartbeat called ventricular fibrillation dangerous.

Kinidin - Anticoagulants

Anticoagulant effect can be increased. Anticoagulants are used to thin the blood and prevent clotting. As a result: increased risk of bleeding. Reported symptoms such as bruising or bleeding in the body, stool black.

Kinidin - Barbiturates

Kinidin effect can be increased. As a result: irregular heartbeat that can not be controlled. Barbiturate used as a sedative or sleeping pills.

Kinidin effects can be reduced. As a result: irregular heartbeat that can not be controlled. Phenytoin is used to mngendalikan seizures in disorders such as epilepsy.

· Beta blockers heart drug interactions

Beta blockers - Alcohol

This combination can cause blood pressure to drop too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting; severe drop in blood pressure which can lead to seizures or shock. This interaction can be minimized by reducing alcohol consumption.

Beta blockers - Amphetamines

Effects of beta blockers resisted. As a result: disorders treated with beta blockers can not be controlled. This combination can also be paradoxical increase in blood pressure dangerous with symptoms such as fever, headache, visual disturbances,. Amphetamines are used as a slimming pill (not recommended), to address behavior problems in children and for narcolepsy.

Beta blockers - drugs angina / antiaritmika

This combination can cause blood pressure to drop too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting; severe drop in blood pressure which can lead to seizures or shock.

Beta blockers - Antacids

Effects of beta blockers can be reduced. As a result: the condition can not be handled properly controlled.

Beta blockers - Antidepressants (Janis MAO)

This combination can cause a significant rise in blood pressure. Al reported symptoms irregular heartbeat, fever, headache, visual disturbances. Imao antidepressants are useful to reduce mental depression and improve mood is not used much anymore since developed type of cyclic antidepressants such as Elavil and Sinequan.

Beta blockers - Antidepressants (type cyclic)

Eek beta blockers can be reduced. As a result: a heart condition that could not be handled properly controlled. Antidepressants are used to reduce mental depression and improve mood.

Beta blockers - antipsychotics

This combination can cause blood pressure to drop too low and the effect of beta blockers may increase. Symptoms of low blood pressure are reported al dizziness, weakness, fainting. Akkibat reported symptoms of beta blockers is too much: bradycardia, fatigue, heart arrhythmia, breathing berdengik as in asthma or breathing difficulties. Antipsychotics is a major trankulansia used to treat severe mental disorders like schizophrenia. Generally, a class of phenothiazine antipsychotics.

Beta blockers - medicines Asthma

Effect of theophylline on asthma will be resisted. Asthma medication is used to open the airways in the lungs and make breathing asthma patients. As a result: the bronchial tract can not open wide enough to cope with an asthma attack.

Beta blockers - Barbiturates

Effects of beta blockers can be reduced. As a result: conditions treated by beta blockers can not be controlled.

Beta blockers - Preparations flu / cough lozenges containing nasal

Effects of beta blockers may be resisted. As a result: conditions treated by beta blockers can not be controlled. Medicinal preparations containing nasal decongestant Idung can be absorbed into the bloodstream and can cause interactions.

Beta blockers - drugs diabetes

This combination may increase or reduce the effects of diabetes drugs. As a result: if the effects of diabetes drugs increased, blood sugar levels can drop too low. symptoms of hypoglycemia were reported, which will be more apparent on physical activity or sport: sweating, anxiety, fainting, fatigue, confusion, cardiac arrhythmias, takhikardia, bleary, and vision problems. If the effects of diabetes drugs reduced blood sugar levels will remain too high. Reported symptoms of hyperglycemia: extreme thirst, urine output much, weight loss, hunger, lethargy, drowsiness and bleary-eyed. Heart medication beta blockers used for angina, normalize irregular heartbeats and help lower blood pressure.

Effects of beta blockers may be resisted. As a result: conditions treated by beta blockers tk can be well controlled. Phenylpropanolamine is a nasal decongestant that is a major component in the counter slimming pills due to side effects which can suppress appetite.

Beta blockers - vasodilators

This combination can cause blood pressure to drop too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting; severe drop in blood pressure that would cause seizures or shock. Vasodilators dilate blood vessels and is used to treat disorders caused by poor blood circulation, such arterioskerosis.

· Digitalis Drug Interactions

Digitalis group - Amphetamines

This combination can lead to cardiac arrhythmias. Amphetamines are used as a slimming pill (not recommended), to address behavior problems in children, and to markolepsi.

Digitalis group - Asthma medication (epinephrine group)

This combination can lead to cardiac arrhythmias. Asthma medication is used to open the airways of the lungs and make breathing bronchial asthma.

Digitalis group - Preparations flu / cough lozenges containing nasal

This combination can lead to cardiac arrhythmias. Nasal decongestant preparations can be absorbed into the blood and cause interactions Liran.

This combination can lead to cardiac arrhythmias. Phenylpropanolamine is a nasal decongestant that is a major component in the counter slimming pills, because the side effects dapay suppress appetite.

Digitalis group - Diuretics

This combination can be detrimental to the heart. Diuretics remove excess fluid in the body and used the heart rate and high blood pressure. Generally diuretics reduce the body's potassium levels. Lack of potassium causes the heart to become very sensitive to digitalis and increased risk of digitalis toxicity with symptoms: nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradycardia, takhikardia, and cardiac arrhythmias.

Digitalis group - Laxatives

This combination can be detrimental to the heart. Laxative reduce body potassium. Lack of potassium causes the heart is very sensitive to digitalis and increased risk of digitalis toxicity with symptoms: nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradikardai, takhikardia, and cardiac arrhythmias.

Digitoksin - Barbiturates

Digitoksin effects can be reduced. As a result: a heart condition that can be dealt with digitoksin not well controlled.

Digoxin (Lanoxin) - Antacids

Effects of digoxin may be reduced. As a result: a heart condition that can be dealt with digitoksin not well controlled.

Digoxin (Lanoxin) - methyldopa (Aldomet, Aldoril)

This combination can be detrimental to the heart. Methyldopa is used to treat high blood pressure. Symptoms reported al bradycardia, dizziness, fainting, confusion, and forgetfulness.

Digoxin (Lanoxin) - Antibiotics tetracycline

Digoksi effect can be increased. As a result: adverse side effects can occur from too much digoxin. Al reported symptoms of nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradycardia, takhikardia, and cardiac arrhythmias.

Cardiovascular medicine calcium blockers - Beta Blocker

This combination can be detrimental to the heart. If the two drugs are given together, the physician should carefully monitor their effects on patients. Beta blockers used to treat heart problems and high blood pressure.

Calcium blockers - digoxin

Digoksi effect can be increased. As a result: adverse side effects can occur from too much digoxin. Al reported symptoms: nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradycardia, takhikardia, and cardiac arrhythmias.

Medicinal plants Heart Disease

Plants are used by humans for thousands of years for medicinal purposes. In this approach it is stated that, interference with one of the organs will cause an imbalance of other organs. If the balance of the body's problems can not be resolved, then there will be health problems. Treatment performed by healers aims to help the natural healing and restore the health of people in balanced conditions, not only eliminate the symptoms.

The main principle of treatment with medicinal plants is important to use total plant extracts, not pure or artificial substance isolation of certain specific functions, especially synthetic materials. Constituent chemical diversity in plants can result in extensive activity in the body. The chemical compound will work together so as to eliminate possible side effects and may provide the ability to work in unison. Thus, the amount of compound required relatively little compared pemakaina single compound.

A number of plants are scattered in nature containing steroid glycosides with 23 or 24 carbon atoms which can strengthen the effect on the heart is weakened.

In the plants, cardiac glycosides present in seed plants. Commonly found in many parts Apocynaceae and Asclepiadaceae, but also found in some plants Liliaceae, Ranunculaceae, and Euphorbiaceae.

· Increased vasodilator effects and side effects including severe hypotension and myocardial ischemia may occur when used with nifedipine grapefruit.

Cardiovascular Drug Interactions Plants

· Allii nightingale sativa (garlic)

Aliin mangandung fresh tubers from 0.2 to 1.0%. Aliin or S-allyl-L-Cysteine ​​is a compound soluble in water, and its chemical formula is (-)-5-allyl-L-Cysteine-solfoksida, which can be hydrolyzed by the enzyme activity alisin aliinliase form, ammonia, and acid ketoasetat.

Aliin hemihidrat compound which is colorless and crystallized in the form of needles with acetone solvent. Molecule has two centers of asymmetry that can have four isomers, two of which were derived from L-Cysteine ​​and D-Cysteine ​​nature. The fourth isomer has to be synthesized and the one that is identical to the natural aliin is (-)-S-allyl-L-Cysteine ​​sulfoxide.

Alisin unstable and can decompose during distillation or hydrolyzed by water or sodium carbonate to form polysulfide compounds, dialilsulfida, which cause the bad smell of essential oil. Hydrolysis decomposition that can be isolated is already trans compound - and / or cis-ajoen, 2-vinyl-[4H] -1,3-ditiin, 3-vinyl-[4H] -1,2-ditiin, dialiltrisulfida and metal- allyl-trisulfida.

· Allii cepae bulb (onion)

The main components of this bulb is compound oxide-S bond with amino acids, namely zikloaliin (levels up to 2%) and homologous propel-and / or propenyl-of aliin. In the enzymatic dissociation can occur storage form tiosulfinat acid ester, sulfinildisulfida (sepain), di-and polysulfide, and tiopen. The smell of the bulbs was caused by the presence of substances propantial-S-oxide, which causes eye pain and spend a lot of tears.

· Purpureae Folium Digitalis (Digitalis leaves)

Of the digitalis leaf could have isolated more than 30 types of glycosides kardenolida with levels from 0.15 to 0.4%. Primary glycosides (purpurea glycoside A, purpurea glycoside B, and glukogitaloksin) all have genin at 3 C atoms form linear chains of group 3 digitoksosa sugar and topped with glucose. Active components dry matter of Digitalis purpurea is digitoksin (± 12%), as well as gitoksin, and gitaloksin (± 10%).

Worm infection is one of the most common diseases spread and infect more than 2 billion people around the world. In general, worms rarely cause serious illness, but it can lead to chronic health problems, which is a very important economic factor. Infection can occur simultaneously by several types of worms at once. It is estimated that more than 60% of children in Indonesia suffer from a worm infection.

Transmission

Worm infections generally occur through:

Mouth

Sores on the skin

Eggs or larvae that exist everywhere on the ground (worm eggs out of the human stomach with feces, if the waste is discharged into the environment then it would make more luas.Contohnya spread if spread in the river, then the worm eggs will contaminate "the river water , food, wind "). Diagnosis: Microscopic examination of eggs or larvae in the feces, urine, blood and tissue. This determination is important because the drugs work mostly depends on the type of worm parasites.

Symptoms of Worms

Itching of the anus or feet, diarrhea, constipation, abdominal pain and small bowel obstruction and pancreatic ducts.

Symptoms or complaints may be caused by the toxic effects of substances exchange products worms, intestinal obstruction and bile duct (obstruction) or withdrawal of essential nutrients for the body. Often the symptoms are not so obvious and the only form of gastrointestinal disorders, such as nausea, vomiting, heartburn, diarrhea, convulsions and loss of appetite periodically with (anorexia).

Prevention

Common actions that need to be done is to obey hygiene rules firmly and consistently, especially in children. For example precautions taken:

Wash hands with soap before and after waking up, after defecation and before eating and cut fingernails and do not bite your nails.

Wear footwear.

Not to snack at any place, let alone snacks open

Wash vegetables and fruits before eating the first running water or dip it a few seconds in boiling water, and the meat should be cooked until matah right before eaten.

Clothing and room: give the kids in tight pants to avoid contact between the finger and the rectum, the bedrooms are regularly cleaned.

At the same time, children who suffer from intestinal worms must be treated immediately. However, despite all of the children are taking medication worms, worms do not mean the problem will be completed on the spot

Do not eat anything that has been dropped on the ground without washing thoroughly first.

Thus oral infection most often occurs, can be avoided. In eradicating worm infections common hygiene measures need to be taken which includes housing improvement, social and economic environment.

Types of worms

Worms are parasites that humans can be divided into 2 groups, namely:

Plathelminthes (flatworms). Characteristics: flat shape and does not have a body cavity.

Nematode (Roundworm): Oxyuris (Kermi worms), Ascaris (roundworm), Ancylostoma (hookworm), Strongyloides and Trichuris (whipworm). Infection can occur through egg, larva or worm itself, through the mouth or through the skin.

As for the types of worms that infect humans are:

Pinworms, pinworms spread is more common in cold regions. The female pinworm measuring 8-13 mm x 0:44 mm with a long tail and pointy looking male pinworms measuring 2-5 mm with a circular tail. Berrkisar worm life cycle between 2 weeks to 2 months. Pinworm transmission and transmission is affected by dust from hand to mouth. Diseases caused by pinworms known Enterobiasis. That places the inflammation around the rectum and the vagina girls inflammation. The introduction is through examination of the skin around the anus.

Bracelet worms, roundworms, similar to worms tanahpanjang 10-30 cm, small intestine dironggo life. This worm landed on the dog, the eggs can be removed with the feces of infected children when playing in the dust and be ingested by humans through food terkontamonasi. The eggs will hatch in the intestine, and then develop into larvae penetrate the intestinal wall and into the lungs. After adult roundworms will inhabit the human gut and invade the food there so that causes people to suffer malnutrition because food intake is absorbed by roundworms. Moreover cause intestinal blockage and inflammation of the appendix or pancreatic lobe. The introduction is through a fecal examination, where the worms and eggs with a real egg obvious.

Whip worms, whip-like shape, 3-5 cm long. Infection occurs through the egg in water and food. Spreading occurs when swallowing whipworm eggs. In children whipworm can be found throughout the colon and rektum.Gejala per4mukaan that may occur in this disease is anemia. As a result, the children flocked cause inflammation of acute appendicitis or peritonitis. There are no worms in stool, only eggs that can be recognized by the microscope.

Mine worm, this worm length between 6-12 mm. Has 4 teeth were similar, 90% of these infections are caused by N. Americanus. Hookworm eggs out along with feces, within 1 1.5 days the eggs will hatch into larvae called rhabditiform larvae. Three days later the larvae turn into filariform larvae that can penetrate the skin lareva feet and into the human body. In the human body, following the moves of hookworm bloodstream, heart, lungs, throat, and swallowed kemudiaan into the intestine. In the intestine, the larvae become adult worms are ready to suck the blood of so dangerous because it can cause anemia in humans. The symptoms are itching in the legs and cough with increasing temperature.

Thread worms, worm infection worms live in the soil, infection occurs through the larvae penetrate the foot. The symptoms are intense itching in the anal area and inflammation of the skin. The introduction of the infection can be identified and thread worm larvae feces that do not contain eggs. The introduction can be recognized from larvanyha in the stool, which does not contain eggs.

Ribbon worm, this worm length 60 cm in T. Solium and 2 m in T. Saginata found in beef liver. Consequently dangerous penetrate the intestinal wall, blood circulation and to other organs such as the brain, liver and lung. Transmission occurs by eating meat that has not been cooked long enough and still contain worm eggs. After hatching, the larvae grow into worms in the gut cavity. The introduction can be recognized from the eggs and ruasnya (3 cm long, 1 cm wide) are present in the feces.

Breeding Worms

Community widespread worms in the stomach easily. As an illustration, an adult female roundworm can produce 200,000 eggs per day. If there are five in the belly of the tail, they can produce a million eggs a day. Only egg size in units of microns (1 micron is one thousandth of a millimeter). So small, the eggs can only be seen with a microscope.

Type Worm Disease

Ascariasis: Mebendazole, pyrantel, Albendazole, piperazine. Ascaris lumbricoides (roundworm) 10-15 cm in length and usually reside in the small intestine. Transmission occurs through food by infected eggs and larvae that develop in the small intestine. The larvae penetrate the intestinal wall, through the heart and then to the lungs. After reaching the throat, then swallowed and breeding larvae into adult worms in the small intestine. Treatment: Mebendazole, Albendazole and pyrantel is the drug of first choice. Kur often have to be repeated with a second chair, because not all worms or eggs can be destroyed.

Oxyuriasis: Mebendazole, pyrantel, Albendazole, piperazine. Enterobius vermicularis (formerly called oxyuris) or worms that are common in Kermi coecum, cause itching around the anus and severe convulsions in children. Sometimes these infections cause inflammation of the lobe acute appendicitis (appendicitis). Transmission in young children is often the case with the auto-reinfection, ie, through the eggs attached to the fingers while scratching the anal area, which felt very itchy and thus allowing secondary infections. The cause is the female worms are 8-13 mm in length, which is in between the hours of 8-9 nights out of the anus to lay eggs on the skin around the anus. Kermi worm infection is an infection of worms that is the only transmission takes place from person to person, so that all family members should be treated simultaneously as well, although they do not show any symptoms. The cause is the new female worms lay their eggs between 3-6 weeks after infeksi.Terapi: Mebendazole, Albendazole and pyrantel no lethal eggs so after 2 weeks of worms that hatched should be turned off by the second chair. Piperazine is the second choice drug.

Taeniasis: Praziquantel, niclosamide. The most common tapeworm Taenia solium there is, T. Saginata there is lots of pork / beef, fish also. Transmission occurs by eating meat that is not cooked long enough and still contain larvae. Taenia difficult to eradicate, because the fist (scolenya) a relatively small embedded into the intestinal mucous membrane to terkenan no cure. Worms parts (segments) that come into contact with drugs and had been turned off, removed from the scolex which then makes new segments (regeneration). Segments and their eggs can be recognized in the stool, but scolexnya usually digested by the nodes usus.Terapi: the first choice drug Praziquantel and niclosamide.

Ancylostomiasis: Mebendazole, Albendazole. There are 2 types of worms that Necator americanis Mine are mainly found in the United States and Ancylostoma duodenale are found in tropical / subtropical and length of approximately 10 mm. Transmission occurs by the larvae enter the broken skin on the feet and cause local reactions. Having entered the vein, the larvae to the lungs and bronchi ultimately to the gastrointestinal tract. Hookworm is also associate themselves with the intestinal mucosa and suck blood host to serious anemia. Treatment is directed at two objectives, namely improve blood picture (nutritious foods and iron compounds) and eradicate the worm. Mebendazole and pyrantel worm medicine is the first choice as well as to eradicate roundworm infection when mixed.

Strongyloidiasis: tiabendazol, Ivermectin, Albendazole. Strongyloides stercooralis (thread worms) found in the tropics and subtropics. Transmission through the thread-shaped larvae penetrate the skin. The larvae can be recognized in the stool, which does not contain eggs. Since the auto-reinfection occurs, the worms can survive for decades in the mucosa of the upper small intestine. In this place, the worms cause inflammation and damage. Typical symptoms are intense itching (urticaria) on the rear, which is temporary, also stomach upsets and respiratory irritation (cough) due to migration of worms. Treatment: Tiabendazol and Ivermectin is the drug of first choice for thread worms. Albendazole is also effective.

Trichiuriasis: Mebendazole, pyrantel, Albendazol.Trichiuris trichiura (whipworm) in the state are generally hot and humid climates. Contained in coecum (appendectomy) and settles in the ileum and colon mucosa, with causing damage and inflammation. Eggs are excreted in feces and used for diagnosis. Eggs can be grown in the ground. Transmission occurs through infected food and water. Symptoms in young children can lead to acute appendicitis. Due to blood loss anemia may also occur. Treatment is done effectively with Mebendazole, pyrantel, and Albendazole.

Filariasis: Dietilkarbamazin (DEC) and Hetrazan. Wucheria bancrofti (filarial worm) is a family of filarial nematodes, which cause tropical diseases elephantiasis (elephantiasis). Inflammation of the lymph vessels to the blockage followed by adult worms (8-10 cm in length). As a result, hypertrophy of these tissues, especially in the legs that can grow up to 30 cm diameter. Transmission to humans occurs through the mosquito Culex fatigans, which stung by night. Treatment: Dietilkarbamazin especially when administered at an early time, sometimes requiring surgery to repair a lymph drainage and remove excess tissue.

Schistosomiasis: Praziquantel. Schistosoma haematobium (flatworms) are not segmented worms and schistosomiasis are the cause of the disease is transmitted by a type of carrier snail larvae. Once developed, the parasites penetrate human skin and enter the blood circulation. Transmission occurs by cercariae, typical forms are released into the water by which the host (snail) which then penetrate human skin or mucous membranes. Sexual cycle occurs in humans with the formation of eggs excreted in feces or urine. In the water, out of the eggs and larvae infect snails, which produced tens of thousands of cercariae. Treatment: Medication is the first choice for all types of schistosomiasis Praziquantel that attack humans.

Helminthic

Anthelmintics or worming (Greek = anti = opponent, helmins = worm) is a drug that can destroy worms in humans and animals.

Many antelmintika have efficacy against 1 or 2 types of worms. Only a few drugs that have efficacy against more types of worms (broad spectrum), eg: Mebendazole.

Various Kinds of Drugs Worms

Mebendazole: tiabendazol, albendazole.

very effective against pinworms, bracelets, ribbon, whip and mine.

Widely used as monotherapy for the treatment of mass deworming, also in mixed infections 2 or more worms. Working as vermicid, larvacid and ovicid.

Mechanism of action: counteraction revenue and accelerate the use of glucose (glycogen) in the worm.

Dosage: Children and adults alike, the Oxyuriasis single dose of 100 mg at breakfast time. In the roundworm infection, mining, thread, ribbon and whip 2 dd 100 mg for 3 days, if necessary, be repeated after 3 weeks.

2. Piperazine: Upixon

Oxyuris and highly effective against Ascaris.

Worms paralyzed and then removed from the body by the intestinal peristalsis, as well as efficacious laksan weak.

Widely used because it is effective and inexpensive, but in many western countries since 1984 is not used anymore because of side effects, especially neurotoxicity.

Dose: Ascaris: 75 mg / kg or a single dose of 3 g for 2 days. Oxyuris 65 mg / kg or a single dose of 2.5 g for 7 days.

4. Levamisole

Effective against Ascaris, hookworms.

Side effects are rare, which is an allergic reaction (rash), granulocytopenia and other blood disorders

5. Niclosamide: Yomesan

Highly effective against tapeworms human / animal

Mechanisms: increased sensitivity to the protease enzyme that worm worm easier to digest.

Almost no side effects, but these drugs are highly toxic, its use must be careful to increase resorption disorders (colitis and bowel injuries).

Definition
Chikungunya fever is an endemic disease (applicable to the sector in the region or population often). Chikungunya virus was first identified in East Africa in 1952. Chikungunya comes from Shawill based on patient symptoms, which means (body position) twisted or curved, referring to the bent posture of the patient due to severe joint pain (arthralgia). The joint pain in the knees and ankle joints of the hands and feet.

Cause
Chikungunya fever is caused by Chikungunya virus (CHIKV). CHIKV belongs to the family Togaviridae, alphavirus genus, and is transmitted by the mosquito Aedes aegypti.

Modes of Transmission
Chikungunya may be said to be 'brothers' with high fever and dengue denggi as transmitted by the same carrier Aedes aegypti and albopictus. The difference, if denggi dengue virus invade the bloodstream, Chikungunya virus attacks the joints and bones. Aedes mosquito bites a person who would normally have been infected by chikungunya virus and move blood to a healthy other prey.

Symptom
Chikungunya symptoms-the clinical symptoms are very similar to denggi fever. Chikungunya typically starts with a sudden high fever that reached 390 ° C other symptoms such as chills, rash on legs, hands and body no appetite headache, red eyes, photophobia (sensitivity to light) and vomiting.

The main symptoms of Chikungunya disease is the body suddenly felt a fever followed by rheumatic pain in joints. In fact, because one typical symptom is the emergence of a sense of fatigue, pain, pain may also arise in the bones, there are named as bone fever or flu-bone. In some cases also found that infected patients without causing any symptoms at all or silent chikungunya virus.

This disease does not cause death. Pain in the joints will not cause paralysis. After over five days, the fever gradually subsided, feeling pain or pain in the joints and muscles is reduced, and the sufferer will recover to normal. Patients in some time and then can move her body as usual. Although in some cases the pain is still lagging sometimes for days to months. Usually this condition occurs in patients who previously had a history of frequent bone pain and muscle.

Diagnosis
To obtain an accurate diagnosis needs some serologic tests such as obstacle agglutination test (HI), serum neutralization, and IgM capture ELISA. But this is only bermanfaant serology is used for epidemiological and research interests, not useful for practical purposes everyday clinical.

Treatment
Chikungunya fever include? Self Limiting Disease? or illness that resolves on its own. There is no vaccine or specific drug for this disease. Treatment given only symptomatic therapy or eliminate the symptoms of the disease, such as pain relievers or fever as class paracetamol . Should avoid the use of similar drugs aspirin. Antibiotics are not needed in this case. Use of antibiotics to prevent secondary infection is not considered useful. To improve the general condition of the patient is recommended to eat nutritious foods, especially carbohydrates and sufficient protein and drink as much as possible. Expand consume fresh fruit or fresh fruit juice.

Granting immunity-enhancing vitamins may be beneficial for the treatment of disease. In addition to vitamins, foods that contain enough protein and carbohydrates also increase endurance. Endurance is good and adequate rest can accelerate the healing of disease. Also advised to drink lots of fluids to address the need to increase the time of fever.

Prevention
The only way to avoid this disease is to eradicate mosquitoes carrying the virus. This mosquito, happy to live and breed in stagnant water such as a bathtub, flower vases, and also cans or bottles that hold water.

Black and white patterned mosquito is also happy to live in objects such as clothes hanging on the back door. In addition, this mosquito also enjoys place dark and stuffy.

Given the spreading of this disease is the mosquito Aedes aegypti then the best way to break the chain of transmission is to combat the mosquito, as is often suggested in the fight against dengue fever.

Insecticide used to kill mosquitoes is from malathion group, whereas themopos larvae-larvae to turn off.

Malathion is used by way of fumigation, not by spraying into the wall. This is because the Aedes aegypti do not like to rest on the walls, but the hanging objects. However, prevention is cheap and effective way to combat mosquitoes is to drain the clean water reservoirs, bath, flower vases and so on, at least once a week, since mosquitoes are breeding from the egg to mature within a period of 7-10 days .

Yard or gardens around the house must be clean of objects that allow rainwater clean, especially during the rainy season like now. Doors and windows should be open every day, from morning till evening, so that fresh air and sunlight to enter, resulting in the exchange of air and healthy lighting. Thus, creating an ideal environment for the mosquitoes. How to prevent an outbreak of chikungunya is to reduce outbreaks of mosquito ketahap maximum. This includes breeding larvae destroy the nest to stop the life cycle and transmission. There are various ways to protect yourself from mosquito bites, among others:

Individual prevention can be done in a special way as the use of skin ointment (insect repellent) containing the active ingredient DEET or other EPA. The use of long sleeves and long pants are also recommended for certain areas in the state is an increase in cases, bed use mosquito nets and mosquito ambush on casement pairs.

Preliminary
Drug interaction is a change in the effect of a drug due to the use of other drugs (drug-drug interactions) or by food, traditional medicine and other chemical compounds. Significant drug interactions may occur if two or more drugs are used together.
Drug interactions and adverse drug reactions need attention. An American study showed that each year nearly 100,000 people had to be hospitalized or have to stay in hospital for longer than it should, even in cases of death due to interactions and / or side effects of drugs. Patients who were admitted to hospital often receive therapy with polypharmacy (6-10 kinds of drugs) as the subject for more than one doctor, so it is very possible drug interactions mainly affected the severity of illness or age.
Clinically important drug interactions result in increased toxicity when and / or a reduction in drug effectiveness. So keep in mind, especially when it comes to drugs with narrow safety margin (therapeutic index is low), such as cardiac glycosides, anticoagulants and cytostatic drugs. It is also worth noting the drugs commonly used together.
Incidence of hard drug interactions in clinical estimate because:
a. documentation is lacking
b. often escaped notice, due to lack of knowledge of the mechanisms and the possibility of drug interactions. This resulted in drug interactions include increased toxicity seen as idiosyncratic reaction to one drug, while the form of interaction penurunakn effectiveness ascribed the increased severity of illness of patients
c. the incidence or severity of drug interactions are influenced by individual variations, in which certain populations more susceptible such as geriatric patients or severely diseased, and could also be due to differences in metabolic capacity between individuals. In addition, factors specific diseases, especially renal failure or severe liver disease and other factors (large doses, the drug ingested together, chronic administration).

Mechanism Drug Interactions
Interactions are classified by involvement in a process of pharmacokinetics and pharmacodynamics. Pharmacokinetic interaction is characterized by changes in drug plasma levels, area under the curve (AUC), onset of action, half time, etc.. Pharmacokinetic interactions caused by changes in the rate or extent of absorption, distribution, metabolism and excretion. Pharmacodynamic interactions are usually associated with the ability of a drug to alter the effects of other drugs without altering the properties of farmakokinetiknya. Pharmacodynamic interactions include additive (A drug effect = 1, B = 1 effects of drugs, the effects of a combination of both = 2), potentiation (effect A = 0, B = 1 effect, the effect of the combination of A + B = 2), synergism (effect A = 1, the effect of B = 1, the effect of the combination of A + B = 3) and antagonism (effect A = 1, B = 1 effect, the effect of the combination of A + B = 0). Mechanisms involved in the interactions are pharmacodynamic effects of changes in tissues or receptors.

Pharmacokinetic interactions1. Absorption
The drugs are taken orally bisaanya absorbed from the gastrointestinal tract into the circulatory system. There are many possibilities for drug interactions occur through the gastrointestinal tract. Drug absorption can occur through passive and active transport, where most of the drug is absorbed passively. This process involves the diffusion of the drug from an area with a high concentration to areas with lower levels of medication. On the displacement of the drug active transport against a concentration gradient (ie ion-ion and water-soluble molecules) and this process requires energy. Absorption of active drug transport is faster than in the passive tansport. Drugs in the form of non-terion fat soluble and easily diffuses across the cell membrane, whereas the drug in the form of fat and insoluble terion can not diffuse. Under normal physiological conditions, but the level of absorption is slightly delayed absorption is usually perfect.
When the absorption rate changes, significant drug interactions will occur more easily, especially drugs with short half-life time or when needed peak plasma levels were quick to get the effect. Interaction mechanism due to impaired absorption, among others:
a. Direct interaction
Interaction physically / chemically between drugs within the lumen of the gastrointestinal tract before absorption can interfere with the absorption process. This interaction can be avoided or greatly dikuangi when interacting drugs are given within a period of at least 2 hours.
b. pH changes in gastrointestinal tract
Gastrointestinal fluid alkalis, for example due to antacids, will increase the solubility of drugs that are poorly soluble acid in the gastrointestinal tract, such as aspirin. Thus aspirin accelerated by alkaline dissolution will accelerate absorption. However, the atmosphere alkalis in the gastrointestinal tract reduces the solubility of a drug that is alkaline (eg, tetracycline) in the gastrointestinal fluids, thereby reducing absorption. Decreased gastric acidity by antacids will reduce the destruction of drugs that are not acid resistant thus increasing bioavailabilitasnya.
Ketoconazole is taken by mouth requires a medium acid to dissolve the required amount so as not allows supplied with antacids, anticholinergic drugs, inhibition of H 2, or proton pump inhibitors (eg, omeprazole). If necessary, the drug should be abat-given at least 2 hours after administration of ketoconazole.
c. formation of insoluble complexes or chelate, and adsorsi
The interaction between the antibiotic group fluorokinolon (ciprofloxacin, enoksasin, levofloxacin, lomefloksasin, norfloxacin, ofloxacin and sparfloksasin) and divalent ions and trivalent (eg Ca 2 + ions, Mg 2 + and Al 3 + from antacids and other drugs) can cause a decrease in significant gastrointestinal absorption, bioavailability and therapeutic effect, because formation of complex compounds. This interaction also decreases the activity of fluoroquinolone antibiotics. This interaction effect can be significantly reduced by providing an antacid a few hours before or after administration of fluoroquinolones. If antacids are really needed, adjustment of therapy, such as drug-pbat replacement with H 2 receptor antagonists or proton pump inhibitors do.
Several antidiarrheal medication (containing attapulgite) adsorb other drugs, resulting in lower absorption. Although there is no scientific research, use of these drugs should interval with other drugs as long as possible.
d. drug being bound to the bile acid sequestrant (BAS: bile acid sequestrant)
Cholestyramine and kolestipol can bind to bile acids and prevents reabsorpsinya, consequently bonding can occur with other drugs, especially acidic (eg warfarin). We recommend the use of interval kolestipol with cholestyramine or other drugs as long as possible (minimum 4 hours).
e. changes in gastrointestinal function (acceleration or slow emptying of the stomach, changes vaksularitas or gastroduodenal mucosal permeability, or damage to the intestinal wall mucosa).
Examples of drug interactions on the absorption process can be seen in the following table:

Among the above mechanisms, the most significant is the formation of insoluble complexes, chelate formation or if the drug is bound resin that binds bile acids. There are also some drugs that alter the pH of the gastrointestinal tract (eg, antacids) which resulted in significant changes in drug bioavailability.

.1. Distribution

Once the drug is absorbed into the circulatory system, drugs brought into the workplace where the drug will react with a variety of body tissues and or receptors. During their stay in the bloodstream, the drug can be attached to various blood components, especially protein albumin. Fat-soluble drugs have a high affinity to adipose tissue, so drugs can be stored in the adipose tissue. The low blood flow to the tissue resulting in fatty tissue into depot for fat-soluble drugs. This prolongs the effects of the drug. The drugs are highly lipid soluble groups such as phenothiazines, benzodiazepines and barbiturates.

Number of acidic drugs have an affinity for blood proteins, especially albumin. The drugs have an alkaline affinity binding to α-acid-glycoprotein. Plasma protein binding (PPB: plasma protein binding) expressed as a percent indicating percent bound drug. Albumin-bound drug is pharmacologically inactive, whereas drugs that are not tied, commonly called fractions free, pharmacologically active. When two or more drugs are highly bound to protein is shared sasam, competition binding occurs at the same place, which resulted in a shift in one of the drug binding to the protein, and it finally happened peninggatan free drug levels in the blood. When the drug displaced of proteins by binding with other drugs, there will be increased levels of free drug is distributed through various networks. Albumin levels in patients with drug-free or active form will be higher.

Valproic acid was reported to shift phenytoin of bonds with proteins and also inhibits the metabolism of phenytoin. If patients take both drugs, unbound phenytoin levels will increase significantly, causing more side effects large. Conversely, phenytoin may decrease plasma levels of valproic acid. The second combination drug therapy should be monitored with tight and dosage adjustments made.

Medications that tend to interact on the distribution of the drugs are:

percent protein bound high (over 90%)

bound on the network

has a small volume of distribution

have a low hepatic excretion ratio

have a narrow therapeutic range

has a rapid onset of action

used intravenously.

Drugs that have a high ability to shift to other drugs from protein binding is salicylic acid, phenylbutazone, sulfonamides and nonsteroidal anti-inflammatory.

.2. Metabolism

To produce a systemic effect in the body, the drug must reach the receptor, means the drug must be able to pass through the plasma membrane. For the drug must dissolve fat. Metabolism can change the fat-soluble active compounds into water-soluble compounds that are not active, which will be excreted primarily through the kidneys. Drug metabolism can pass through two phases, namely phase I and II metabolism. In the phase I metabolism, oxidation, demethylation, hydrolysis, etc.. by liver microsomal enzymes that are in the endothelium, produce more drug metabolites water-soluble. In the phase II metabolism, drug reacts with the water-soluble molecules (eg glucuronic acid, sulfate, etc.) into metabolites that are not or less active, which is soluble in water. A compound can pass one or both of the above fasemetabolisme until a water-soluble form. Most of the drug interaction clinically significant result from the phase I metabolism of the phase II.

a. Increased metabolism

Some medications can increase the activity of hepatic enzymes involved in the metabolism of other drugs. For example, phenobarbital increase the metabolism of warfarin thus lowering antikoagulannya activity. In this case the dose of warfarin should be increased, but after discontinued use of phenobarbital dose of warfarin should be reduced to avoid potential toxicity. Can be used as an alternative sedative than barbiturates, benzodiazepines such groups. Phenobarbital also increases the metabolism of other medications such as steroid hormones.

Other barbiturates and drugs such as carbamazepine, phenytoin, and rifampin also cause enzyme induction.

Pyridoxine accelerate decarboxylation of levodopa into its active metabolite, dopamine, in the peripheral tissues. Unlike levodopa, dopamine can not cross the barrier blood brain to provide antiparkinsonian effects. Giving karbidopa (an inhibitor of decarboxylation) together with levodopa, levodopa activity can prevent interference by pyridoxine,

b. Inhibition of metabolism

A drug may also inhibit the metabolism of other drugs, with impacts extend or increase the action of drugs that are affected. For example, allopurinol reduces the production of uric acid by inhibiting the enzyme ksantin oxidase, which metabolizes some potentially toxic drugs such as merkaptopurin and azathioprine. Ksantin oxidase inhibition can significantly enhance the effects of these medications. So if used with allopurinol, merkaptopurin or azathioprine dose should be reduced to 1/3 or ¼ dose usually.

Cimetidine inhibits oxidative metabolic pathways and may increase the action of drugs that are metabolized by this pathway (eg, carbamazepine, phenytoin, theophylline, warfarin and mostly benzodiazepines). Cimetidine did not affect benzodiazein action lorazepam, oksazepam and temazepam, which undergoes glucuronide conjugation. Ranitidine has an effect on oxidative enzymes lower than cimetidine, famotidine and nizatidin while not affect the oxidative metabolic pathway.

Erythromycin reportedly inhibits hepatic metabolism of some drugs such as carbamazepine and theophylline thereby increasing their effect. Fluoroquinolones such as ciprofloxacin drug class also increases the activity of theophylline, presumably through the same mechanism.

3. Excretion

Unless an inhalation anesthetic drugs, most drugs are excreted via bile or urine. Blood enters the kidney along the renal artery, first delivered to the glomeruli tubules, where small molecules that fit through the glomerular membrane (water, salt and some specific drugs) filtered into the tubules. Large molecules such as plasma proteins and blood cells were detained. Blood flow then passes through another part of the renal tubule where active transport to move the drug and its metabolites from blood to tubular filtrate. Tubular cells then perform active and passive transport (by diffusion) for reabsorbing the drug. The interaction can take place due to changes in renal tubules active excretion, changes in pH and changes in renal blood flow.